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4100 – Safe Body Art
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PR0537638
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Entry Properties
Last modified
6/4/2024 1:05:36 PM
Creation date
5/5/2023 10:31:05 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
BILLING
RECORD_ID
PR0537638
PE
4110
FACILITY_ID
FA0021679
FACILITY_NAME
LIVING WATER STUDIOS (PAK, SOPHOLLIE)
STREET_NUMBER
210
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
CURRENT_STATUS
01
SITE_LOCATION
210 N MAIN ST
P_LOCATION
04
QC Status
Approved
Scanner
SJGOV\cfield
Tags
EHD - Public
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i <br /> ¢ SAN JOAQUIN C*TY ENVIRONMENTAL HEALTH LSARTMENT <br /> 1868 E.Hazelton Ave. • Stockton,CA 95205-6232 • Phone(209)46&3420 <br /> Donna Heran,R.E.H.S.,Director <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION <br /> Permit ID# PT0023118 for Record ID# PR0537638 <br /> Valid From 7/1/2013 To 6/30/2014 <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: PAK, SOPHOLLIE <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Facility ID FA00 679 <br /> .Regulated Facility: 2 THS GRAVE-(PAK;'SOPHOLLIE)' account io AR0639325 <br /> 127 UV HARDING WAY <br /> Issued 8/1:9tZ01$, <br /> ,. STOC.KTON CA`95204 <br /> Billing Address: ATTN : PAK, SOPHOLLIE <br /> 2 THE GRAVE (PAK, SOPHOLLIE) <br /> 814 ASTOR DR <br /> ? STOCKTON CA,95210td � <br /> .. _ — <br /> "KL w. .. <br />
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